one - Main themes

Summary

Defining terms

The purpose of this book is to examine the evidence relating to the effectiveness and cost-effectiveness of health promotion policies and projects, specifically but not exclusively in the UK.

First, it is appropriate to clarify, as far as possible, what is generally understood by the key concepts in the health promotion literature. Since this book focuses on health promotion, this phrase needs to be dissected. In addition, definitions – or at least, interpretations of key terms – will be attempted. These include:

• • the ‘new public health’

• • civil society

• • poverty

• • empowerment

Health

Many commentators would consider dictionary definitions rather bland and inadequate. For example, Chambers (2014) defines health as ‘sound physical or mental condition’ (p 704), while the Shorter Oxford English Dictionary (Little et al, 1933) offers two definitions: ‘soundness of body’ and ‘spiritual, moral or mental soundness’ (p.878). None of these three definitions would be acceptable in today's discussions of ‘health promotion’. In 1946, the World Health Organization (WHO) referred to ‘health’ as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. This has been the prevailing definition up to the present day. There is no mention here of spiritual or moral soundness. These two attributes are more likely to be seen today as the province of religious, humanistic or philosophical/ethical discourses.

An additional dimension to health promotion policy has been an acceptance that factors external to the person's individual lifestyle may have a positive or detrimental impact on their health. This is not a recent acknowledgement; as Chapter Two will show, phenomena such as the quality of air, water supply and rivers became public health concerns well before the 19th century, as did housing conditions and the local environment, and remained concerns into and beyond the Victorian era in the UK. A report by The Health Foundation (2017) viewed health from a social determinants approach, which frames good health in terms of the conditions and attributes that maximise health over the life course and offers a fresh perspective:

This view would define a ‘healthy person’ not as someone free from disease but as someone with the opportunity for meaningful work, secure housing, stable relationships, high self-esteem and healthy habits.